The nurse will identify and evaluate potentially preventable inpatient readmissions based on CMS definitions and company criteria. Responsibilities include communicating findings to supervisors and clients and preparing detailed written reports.
This is a remote position.
ROLE:Readmission Review Nurse
LOCATION:Remote, no travelrequired
TERMS:Part-time,non-exempt
SALARY: $35 - $50/hr based on experience
DRG Compliance is a division of FairCode providing DRG Validation services to health insurance plans.
The ReadmissionReview Nursewillcollaborate with supervisor and the designated client(s)’ medical director toidentify, evaluate, and present evidence of inpatient admissions andsubsequentreadmissions as being potentially preventablein accordance withCMS definition and DRG Compliance’s criteria set.
Responsibilities:
Communicatetimelywith supervisor and clientregardingreview findings.
Communicate initial findings for purposes of DRG calculations of recommended changes resulting from combining the stays for coding / payment purposes.
Prepare written report for positive findings and communication comments on trackingsheetfor negative findings.
Monitor tracking sheet for outstanding medical records and keep supervisor informed at least every14 daysof outstanding medical records.
Maintaincurrentdocumentationof processes.Participate in other activities as assigned.
Requirements
An RN with a minimum of 3-5 years experience in Utilization Management in a health plan or hospital setting.
Case Management or discharge planning experience would be a plus but not required.
Must be able to write reports to provide relevant medical record documentation and criteria-based findings.
Excellent written and verbal communication skills, andtheability to work independently with minimal supervision.
Working knowledge of Microsoftproducts such as Microsoft Word, Excel, and Outlook; however, MAC documents compatibleforMicrosoft conversion can be utilized.
Benefits
Remote Position:Enjoy the convenience of working from home or anywhere in the U.S. Work-Life Balance:We encourage a healthy balance between your professional and personal life.
Supportive Team:Join a team of dedicated professionals who value innovation, collaboration, and excellence.
“I was the first applicant for a remote marketing position that got listed on the company website the same day I applied. Had an interview within 48 hours!”
— Sarah J.
·
Marketing Manager
★★★★★
Verified
